Ten RCTs (n=1,438) of bed rest and 8 RCTs (n=1,784) of advice to stay active were included. Two trials (n=228) compared the effects of both bed rest and advice to stay active, and were included in both reviews.
Five of the 10 trials of bed rest and 6 of the 8 trials of advice to stay active met the criteria for 'high quality' (50 out of 100 possible points).
Two trials for bed rest were untypical: one did not address the efficacy of bed rest itself, but of traction, and one was in a military setting. The remaining 8 trials showed that bed rest was not effective. Bed rest was not significantly different from placebo treatments or no treatment. In addition, it was no different or less effective than comparator treatments for rate of recovery, relief of pain, return to daily activities, days lost from work, and recovery of objective clinical measures.
Advice to stay active.
All 8 trials showed consistently positive results. Advice to stay active made no difference to pain or to initial recovery, but increased patient satisfaction. Three trials showed that advice to stay active led to a faster return to work, while one showed no significant difference. Advice to stay active also led to reductions in chronic disability (3 trials), health care use for back pain in the next year (1 trial), and time off work in the next year (3 trials). There was no evidence that early activity had any harmful effects or led to more recurrences.
The 2 trials that compared advice to stay active with bed rest were both of high quality, and showed that ordinary activity produced faster recovery.